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1865 Cliff Lake Ct Oct 07 2014 0826AM HP Fax page 13 Use BIUE or BLACK Ink �----------------, � For Ottice Uae � • i � �.,��,o(�� i Clty of�a�a� � Permit#: � � Perm it Fee: � i�•� � 3830 Pllot Knob Road � � Eagan MN 55122 � Date Received: � Phone:(651)675-5675 I I Fax:(651)675-5694 I Staff: I I I L�....�������`_______J ,� 2014 RESIDENTIAL BUILDING PERMIT APPLICATION Date� r'�'.� � Slte Address• 1�S� ! � � l, / '� l 3i ��G 5'G�,� �a,�� � r unit�: Name: �..7 i`'� ��'=::. ���'`�� f�: �''� v�,. Phone: ResidenU Owner Address/City!Zip:��9'Y!� C� Applicant is: Owner �°`� Contractor -- ,� Description of work: � �° '.c,.� a�'�� --'1 Type of Wcrk I, : Construction Cost: 3 ?S�'Z'�G. `..� Multi-Family Building: (Yes �/No_� ,.- ,,r' y -�°° 1 Company,�'�%��;���u���'Z�2''�✓'���x�: Contact: !,'�,�.�yi.F,`;��;,,.< '. : , .._ ..,�. ,r-�,_, Contractor Address',����c@ v`r2� s��,.;-�; ��.� �:�r�.-����°��s�:.� city: �s��+��t�����,� State��`���'° Zip: .�`� G • Phone:�.( •`j`'' �&'',�(�' )��Emell: ?t�.�G..'��' ' �f��°%' � .�.,�;t�:T�tca .._.ra;^,�.�r}��s.�i. ';�„ • � /e� , � �� � License#: ,�',���e�r�� r�i"l Lead Certiflcate#: •����� a-'`=�'"� ' f If the project is exempt frorn lead certlflcation, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUiLDING In the lasi 12 morrths,has the Clty ot Eagan i�sued a permit for a slmllar plan based on a master plan? _Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: NOTE:P/ans and supportirtg documents thai you subm/t are considered fo be pub/ic intormation. Portlons of the informatlon may be classJf/ed as non pubtic if you provide specific r+easons tfrat wou/d perm/f ihe City to conc/ude fhat!he are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at(651 454-0002 for rolection against underground utility damage. Call 48 hours before you intend to dig to receive locates oi underground utilities. www. o hersta;eonecall ur I hereby acknowledge that this information is complete and accurate; that the wo�k will be in canformance with the ordinances and codes ofthe City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; thet the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Exterlor a-agthorized by a bullding permlt Issued tn accordance wNh the Minnesota State 8ullding Code must completed wlthln 180 da perml�suance. �,_,,...-----:-.:.°.�= F�- ¢�! "�- `� � � '�f,� x � �..-- ��.�`/ X - �'_:_..�+:_,.. - Applicant's Printed Name Applicant's Signature i Page t ot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`"!!"89:'E$*PP'C&-'E XCHC+'DY''::";3XCHC+'DY''::";; S9:"\['39:7"3F!S9:"\['98Z7!W!W 5'N-1-/2'C%&+@$-)H-'NC'5'NCM-'1-C)'N*.'C??$*%C*+'C+)'.C-'NC'N-'*+P1LC*+'*.'%11-%'C+)'CH1--''%L?$2'@*N'C$$'C??$*%C/$-'=C-' P'D*++-.C'=C0-.'C+)'E*2'P'XCHC+'K1)*+C+%-.O (??$*%C+A4-1L*-- '=*H+C01-5..0-)'#2 '=*H+C01- Use BLUE or BLACK Ink r————————————————� I For O�ce Use � I � �b 1 C�� 0� nU �� ± Permit#: � j r � iI � 1J � � Permit Fee: � 3830 Pilot Knob Road � � Eagan MN 55122 � Date Received: � Phone: (651)675-5675 t � Fax: {651)675-5694 I Staff: I i � 2015 RESIDE(VTIAL..�UILDING PERMIT APPLICATION�� ����,z� � �j Date: tL I�/�S Site Address: � �� ��� �� �^c �ow� ����Unit#: ''� �� � � � Name,.w..v .��1����� � �����.,..,_�° �.o�(_,.S_.,�..���.�,. ��..�W�...�_.�.,.,�Phone:�w�...�.,.,.�.v..,�,.�.� ,�W�� i a `" � F�esi�J�r��f � � � OV1�1��;r -� Address/City/Zip: S4�"'�' � � � , � Applicant is� Owner Contractor �..�,,��,.�.W,,�., _��.,,�...�.�.��m,�w,�.�..a..� ,�..a �.,r_.M�.....�. ._,...v_� ._..,_�,��.o�...�_.�,.�,�v�,�...�.,��.._..,..�_.�,...� ¢ � �,�...�...,.��..��..���..��.�..rr��� �3.� � � Description of work: ��n� � Type Of lfd(�rk � � � � Construction Cost:�� ���� ���� ���Multi-Family Building: (Yes �/No� � �,.� �� �� � � /�+ � � i � ( Company:l,l�S �Ytfi�� (��1�G��1� �hc, Contact:��f �1'�t u� ��"' ! � � /y,� � � ` Address: JSGrb �'G�J�7wvr� G�/J � Su/fe ��S/ City: �� � Contraeto�r ; /� � State:�Zip: �5��� Phone: ��3-Sf� .bn'y'�� Email: ��� � �a�.r9�ruy����°`�f,� � � � � � License# �G �D� 7�f.3 Lead Cert�ficate# � � If the project is�exempt from lead certification, please explain�why:�� � ���������������������� �������_�� ,..,.�.a.�.�.- w..�,..e,..,...o�w�.�. �uWR_.�.,.�.m.__�.._.�-ti�....�.���._��,,..�_._.�,..�.�.,,�,...�...w.,�.,�.�,.s��_._.�,�.,.......�...�.M,..�.�......�...,..�.._..._.,..� COMPLETE THIS AREA ONLY IF CONSTRUCTiNG A NEW BUILDING g � In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? � � i � Yes No If yes,date and address of master plan: � � � Licensed Plumber: Phone: � Mechanical Contractor: Phone: � Sewer&Water Contractor: Phone: � Fire Suppression Contractor Phone. � ��IV��7"��.•P���s a�ad��vr�%��do���r�t�f��yo�s�br�a�e co���d to�p�����t#�, Pc��ir�n�af j � f����s�"r�����a�r be ctass���ed a�no�pu�l���ya�pro�t�s��r�a��s E�a���1 p�rr�a�t#��L��y� � .��.,�.� co��f�ql�t�t�� a�re tr�le s�cre�`�. .�..:.:���;.��.i CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of Eagan; that 1 understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Exterior work authorized by a building permit issued in accordance with the Minnesota S t Building Code must be completed within 180 days of permit issuance. �ul f� �rr�o��,��,,.� �_ X e X Applicant's Printed Name Appli s Sign ture Page 1 of 3